Welfare Dependency: Coordinated Community Efforts Can Better Serve Young
At-Risk Teen Girls (Letter Report, 05/10/95, GAO/HEHS/RCED-95-108).

Although poverty and the erosion of families and neighborhoods have put
many teenage girls at risk of pregnancy, school failure, and substance
abuse, programs aimed at helping them are often too little, too late.
However, GAO found that some communities are organizing coalitions with
private and public agencies to integrate services and reach more young
women at risk. This report (1) describes the health and the well-being
of young at-risk teen girls and their families and the condition of the
urban neighborhoods where they live; (2) presents local service
providers' views on what the needs of these girls are; how they are
addressing those needs; and what obstacles service providers may face in
working with the girls, their families, and their communities; and (3)
describes how the communities where these girls live are responding to
the service needs of this group.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS/RCED-95-108
     TITLE:  Welfare Dependency: Coordinated Community Efforts Can 
             Better Serve Young At-Risk Teen Girls
      DATE:  05/10/95
   SUBJECT:  Aid to families with dependent children
             Disadvantaged persons
             Welfare recipients
             Single parents
             Welfare benefits
             Families
             Public assistance programs
             Demographic data
             Minors
IDENTIFIER:  AFDC
             District of Columbia
             Los Angeles (CA)
             Oakland (CA)
             Detroit (MI)
             
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Cover
================================================================ COVER


Report to the Ranking Minority Member, Committee on Finance, U.S. 
Senate

May 1995

WELFARE DEPENDENCY - COORDINATED
COMMUNITY EFFORTS CAN BETTER SERVE
YOUNG AT-RISK TEEN GIRLS

GAO/HEHS/RCED-95-108

At-Risk Teen Girls


Abbreviations
=============================================================== ABBREV

  AFDC - Aid to Families with Dependent Children
  CPS - Current Population Survey
  CRS - Congressional Research Service
  OTA - Office of Technology Assessment

Letter
=============================================================== LETTER


B-254030

May 10, 1995

The Honorable Daniel Patrick Moynihan
Ranking Minority Member
Committee on Finance
United States Senate

Dear Senator Moynihan: 

In recent years, concerns about rising caseloads and long-term
dependence on welfare programs, such as Aid to Families with
Dependent Children (AFDC), have focused attention on the nation's
welfare system.  In 1993, AFDC supported almost 5 million low-income
families across the United States and was projected to cost over $26
billion in federal and state funds in fiscal year 1995. 
Increasingly, concerns have centered on the rising number of teenage
mothers, and particularly on the high public costs associated with
their dependence on programs such as AFDC. 

The forces that place a young teen girl at serious risk of long-term
welfare receipt begin very early.  Recent reports have noted the
positive association between growing up in an adverse environment,
such as an abusive family or an impoverished neighborhood, and future
cognitive, behavioral, and physical functioning.\1 However, the
current mix of education, health, and social support programs has
been unable to mitigate the effects of multiple family problems and
deteriorating neighborhoods on the children being raised in these
environments, particularly young teen girls.  While many federal,
state, and local human service programs target at-risk children and
their families, the programs are not configured and services are not
delivered in ways that maximize their impact on multiple family
problems. 

Because of these concerns, you asked us for information about young
teen girls who may be at risk for AFDC dependency.\2 Specifically,
our focus was the following: 

  describe the health and well-being of young at-risk teen girls and
     their families, and the condition of the urban neighborhoods
     where they live;

  obtain the local service providers' perspectives on the needs of
     these girls, how they are addressing those needs, and what
     obstacles service providers face in working with the girls,
     their families, and their communities; and

  describe how the communities where these girls live are responding
     to the service needs of this group. 

To develop this information, we reviewed the relevant literature,
contacted experts on services for at-risk adolescents, analyzed data
collected by the Bureau of the Census, and conducted site visits in
three urban neighborhoods--Ward 7 in Washington, D.C.; Boyle Heights
in Los Angeles, California; and West Oakland in Oakland, California. 
In addition, we visited a community redevelopment project in Detroit,
Michigan.  (A complete discussion of our methodology and descriptions
of the neighborhoods appear in apps.  I and II.) We did our work in
accordance with generally accepted government auditing standards. 


--------------------
\1 Starting Points:  Meeting the Needs of Our Youngest Children (New
York:  Carnegie Corporation of New York, 1994); and Losing
Generations:  Adolescents in High Risk Settings, National Research
Council (Washington, D.C.:  National Academy Press, 1993). 

\2 For the purpose of this report, we defined young at-risk teen
girls as those who (1) have poor general life circumstances (such as
poverty) or exhibit problematic behavior (such as early sexual
activity) that is associated with problems such as teen pregnancy or
illegal drug use, and (2) generally fall into the age group of 10 to
15 years old. 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

The forces of poverty--eroding the foundations of individuals,
families, and communities--can show some of their most debilitating
effects on young at-risk teen girls.  Service providers in the
neighborhoods we visited characterized many of the 10- to 15-year-old
girls they serve as detached and isolated from their families and
communities, sexually abused and neglected, and threatened by
violence.  A combination of poor economic and social conditions--(1)
poverty and deteriorating neighborhoods, (2) dysfunctional families,
and (3) poor self-image of the young teen girls themselves--has
created a population of adolescents with multiple problems who have
characteristics, such as early parenthood, associated with long-term
public dependency. 

Generally, community service providers told us that services for
at-risk girls aged 10 to 15 were limited, and the services that were
available were often provided after problems reached the crisis
stage.  The services that did exist in the neighborhoods we visited
were not coordinated, and they focused only on the teen and a
specific problem, ignoring, for example, the positive influence a
parent could have and, conversely, the negative impact of a
dysfunctional family.  We also found that these girls (1) received a
lower level of services than other at-risk groups, (2) were offered
few preventive services, and (3) had limited access to the array of
health and support services, provided in a safe environment, that
experts agree are needed by young at-risk teen girls.  Community
service providers told us that the services needed to address sexual
abuse and exploitation, psychological and physical neglect, and drug
and alcohol dependency were nonexistent, unknown or ignored by those
in need, or located far from neighborhoods. 

To better serve and reach more area residents, including young girls,
some neighborhoods are organizing coalitions, led by local providers,
often with assistance from private organizations and public agencies. 
In some cases, these efforts at integrating services have had a
positive effect on neighborhood children.  Some providers, often
working in middle schools, have expanded their role in the community
to better integrate services for at-risk teens and their families. 
Providers working in these coalitions told us they believed the
emergence of neighborhood leadership is critical to the long-term
success of the coalitions.  New service delivery strategies being
tried include identifying and providing multiple preventive services
and activities, contacting parents or guardians and encouraging them
to become involved in their children's activities, and increasing the
community's participation and commitment to the initiative. 


   BACKGROUND
------------------------------------------------------------ Letter :2

There is growing concern among program providers and policymakers
that large numbers of our nation's adolescents--particularly young
girls between the ages of 10 and 15--are at great risk for a number
of problems including pregnancy, alcohol and drug abuse, and school
failure.  Many of these young teens live in poor neighborhoods.\3
According to the 1992 Current Population Survey (CPS), there were
over 7 million girls under 18 years old living in poverty, with over
2.5 million residing in poor neighborhoods.  In addition, as many as
half of all adolescents aged 10 to 15 are reported to be at moderate
or high risk of school failure, early sexual activity, drug and
alcohol use, or criminal behavior.\4 Among the most far reaching and
costly of all negative outcomes for young at-risk girls is early
parenthood.  In 1990, about 361,000 babies were born to unmarried
teenagers--approximately 9 percent of all births in that year.\5


--------------------
\3 A "poverty neighborhood" is defined as a census tract with a
poverty rate of 20 percent or more based on the 1980 census. 

\4 At-Risk Youth, The Urban Institute Policy and Research Report,
Vol.  23, No.  1 (Washington, D.C.:  Winter/Spring 1993). 

\5 Kids Count Data Book 1993:  State Profiles of Child Well-Being
(Washington, D.C.:  Center for the Study of Social Policy, 1993). 


      TEEN BIRTHS RISING AND
      COSTLY
---------------------------------------------------------- Letter :2.1

From 1960 to 1992, the birth rate for all teens increased from 15.3
to 44.6 births per thousand.  While the number of births to the very
young--aged 15 and younger--is not large, this group is experiencing
the greatest rate of increased births.\6 Pregnancy rates for all
girls under 15 years old rose 4.1 percent in the United States during
the period between 1980 and 1988--higher than any other teen age
group.  In addition, these young mothers often have other
characteristics that are associated with long-term welfare dependency
and other long-term problems, such as deficient education and
employment skills and histories of child abuse and neglect. 

The public costs of teen mothers are high.  According to the most
recent Census data available, nearly one-half of all women receiving
AFDC from 1976 to 1992 were or had been teenage mothers (see fig. 
1).  In addition, these women were more likely to be the least
educated and have larger families, thus making them the least likely
to leave AFDC and become self-sufficient.\7 The Center for Population
Options estimated that in 1992 the federal government spent over $34
billion on AFDC, Medicaid, and Food Stamps to support families begun
by teens. 

   Figure 1:  Proportion of Women
   Who Gave Birth as Teenagers Is
   Nearly Half of All Single Women
   Receiving AFDC

   (See figure in printed
   edition.)

Source:  CPS, 1992. 


--------------------
\6 A State-by-State Look at Teenage Childbearing in the U.S.  (Flint,
MI:  Charles Stewart Mott Foundation, 1991). 

\7 Families on Welfare:  Focus on Teenage Mothers Could Enhance
Welfare Reform Efforts (GAO/HEHS-94-112, May 31, 1994). 


      PAST PREVENTION PROGRAMS
      HAVE SHOWN LITTLE SUCCESS
---------------------------------------------------------- Letter :2.2

Generally, teen pregnancy prevention projects have produced less than
encouraging results, whether programs were targeted to prevent teens
from their first pregnancy or additional pregnancies.  For example,
the Office of Technology Assessment (OTA) reviewed pregnancy
prevention programs that attempted to (1) increase teens' knowledge
about reproduction, (2) improve access to contraceptives, or (3)
broaden teens' life options.  OTA concluded that despite some
promising approaches, no evidence existed of significantly reduced
pregnancy rates among teen girls when the approaches were applied
independently. 

Intervening after teens have become sexually active or after they
have given birth appears to be too late for positive impacts,
regardless of the type of program.  For example, a national
demonstration project that provided education and employability
development as well as other supportive services to teen mothers was
unsuccessful at reducing the rate of second pregnancies among teen
mothers.  The developers of this effort recognized the difficulty of
overcoming "serious obstacles to advancement, some psychological in
nature, others related to dysfunctional families, dangerous schools
and neighborhoods, and other factors in their social, physical, and
economic environments."\8

Historically, federal initiatives to address the individual problems
of youths, their families, and teen pregnancy have generally resulted
in "single-problem" programs and reactive, crisis-oriented service
strategies by local providers.  A Congressional Research Service
(CRS) study concluded that some federal programs aimed at reducing
the incidence of teen pregnancy disagree on the federal role,
resulting in a patchwork of differing goals ranging from promoting
abstinence to encouraging the use of pregnancy planning among
sexually active teens.\9 Consequently, federal programs often support
local projects that target one of these goals at the exclusion of
others. 


--------------------
\8 New Chance:  Interim Findings on a Comprehensive Program for
Disadvantaged Young Mothers and Their Children (New York:  Manpower
Demonstration Research Corporation, Sept.  1994). 

\9 Welfare Reform:  Adolescent Pregnancy Issues (CRS, 1994). 


   POOR, DYSFUNCTIONAL FAMILIES
   AND DETERIORATING NEIGHBORHOODS
   IMPACT ON YOUNG AT-RISK TEEN
   GIRLS
------------------------------------------------------------ Letter :3

In neighborhoods with high concentrations of poor families, many 10-
to 15-year-old girls have multiple problems.  The combination of
abuse and neglect in young teens' households and dangerous and
decaying neighborhoods has increased the numbers of young teen girls
with the risk characteristics associated with long-term welfare
dependency, education deficits, and early parenthood.  These girls
are growing up under circumstances that often compromise their
health, impair their sense of self, limit their development
potential, and generally restrict their chances for independent and
productive lives. 


      FAMILY ABUSE AND NEGLECT
      LEAVE YOUNG TEEN GIRLS
      ISOLATED AND VULNERABLE
---------------------------------------------------------- Letter :3.1

In the neighborhoods we visited, family poverty combined with
parental substance abuse and sexual or physical abuse of children
makes growing up a significant challenge for many young girls.  Many
of the girls in these communities lived in households where the
income was below the poverty level.\10 In Washington, D.C.'s, Ward 7,
for example, according to the 1990 census, 18 percent of the
households were considered to be poor.\11 In addition, many of the
girls in the communities we visited lived in single-parent
households, typically headed by their mothers.\12 These households,
as characterized by providers, lacked parental supervision and left
young girls isolated from family members as well as from their
neighborhoods.  The principal of a middle school in West Oakland told
us that many of her female students' parents were abusing drugs or
alcohol, and crime and violence proliferated in their neighborhoods;
one or both parents were often absent; and many of the adults in the
homes did not have the skills and abilities to function as parents. 

Families living in poverty are stressed and constrained by the normal
activities of daily life, which can make parents and children feel
hopeless and helpless.  In our interviews with service providers and
our reviews of recent studies, we found (1) high rates of substance
abuse among the parents of young teen girls, (2) widespread physical
and sexual abuse of teen girls, and (3) many young girls that were
left unattended for long periods of time and who often assumed adult
responsibilities in their homes. 

Factors associated with family dysfunction, such as substance abuse,
were prevalent in all the communities we visited.  Nationally, rates
of drug and alcohol abuse among women living in poverty and AFDC
recipients, for example, have been estimated to range from more than
15 percent to almost 30 percent.\13 Drug and alcohol abuse among
parents was seen as a widespread, serious problem by many
neighborhood providers, as well as by the young teen girls
themselves.  For example, in the West Oakland neighborhood we
visited, the arrest rate for narcotics was more than double that for
all of Oakland.  Boyle Heights in Los Angeles registered almost three
times the rate of alcohol-related arrests as Los Angeles as a whole
between 1991 and 1993.  The Ward 7 community was no different.  The
Director of Recreation for Washington, D.C., said that many of the
young girls the Department of Recreation serves witness daily alcohol
and drug abuse. 

Physical and sexual abuse were also reported by community providers
as significant problems.  In West Oakland, where the reported number
of sexual abuse incidents rose from 49 in 1992 to 91 in 1993, the
Adolescent Family Life Director believed that as many as 65 percent
of the young girls the office serves have been sexually abused.  Some
providers reported that young victims of abuse--characteristically
passive, lacking self-esteem, and pressured into early sex by
extended family members and older men--have few options or role
models and often follow what are seen as common practices in their
neighborhoods.  Providers in residential care facilities for
parenting teens reported that most of their clients were victims of
abuse.  Recent research confirms their observations.  Studies
reported that as many as 68 percent of teen mothers were sexually
abused as children.\14

According to community providers, young girls are often unsupervised
or on their own for extended periods of time and essentially
parenting themselves, which isolates them from their families and
communities and makes them vulnerable to outside influences.  Local
providers believed that many of these girls become the functioning
adult in the household and assume the responsibility of caring for
younger family members. 


--------------------
\10 In 1993, the federal poverty level for a family of three was
$11,521. 

\11 The city of Washington, D.C., is split into eight political
wards. 

\12 Nationally, the percentage of children under 18 living with a
single parent rose from 12 percent in 1970 to 27 percent in 1993. 
More notable, however, is that of those children living with one
parent, the proportion of those living in a never-married household
rose from 24 percent in 1983 to 35 percent in 1993.  Marital Status
and Living Arrangements, Bureau of the Census, Series P20-478
(Washington, D.C.:  Government Printing Office (GPO), Mar.  1993). 

\13 Substance Abuse and Women on Welfare, Center on Addiction and
Substance Abuse at Columbia (New York:  Columbia University, June
1994); and Substance Abuse Among Women and Parents (Washington, D.C.: 
Department of Health and Human Services, July 1994). 

\14 Debra Boyer and David Fine, "Sexual Abuse as a Factor in
Adolescent Pregnancy and Child Maltreatment," Family Planning
Perspectives, Vol.  24, No.  1 (Jan./Feb.  1992); J.  Butler and L. 
Burton, "Rethinking Teenage Childbearing:  Is Sexual Abuse a Missing
Link?" Family Relations, Vol.  39, No.  73 (1990); H.  Gershenson and
others, "The Prevalence of Coercive Sexual Experience Among Teenage
Mothers," Journal of Interpersonal Violence, Vol.  4, No.  204
(1989). 


      NEIGHBORHOODS OFTEN
      DANGEROUS AND DECAYING
---------------------------------------------------------- Letter :3.2

The condition of the neighborhoods where these girls live induces
fear and apprehension throughout the community.  Their high crime
rate, deteriorating infrastructure, and scarcity of commercial
ventures threatens neighborhood children and provides them with few
positive examples of future livelihoods.  The areas we visited also
had high numbers of declining public and private residential housing
units.  Each of these areas started out as a vibrant section of the
city, but a variety of socioeconomic factors over time has caused
these areas to deteriorate, leaving vacant and dilapidated buildings
and reduced community resources.  (Fig.  2 contains photographs of
the neighborhoods we visited.)

Crime is an important contributor to the destruction of a community. 
Young teen girls in the neighborhoods we visited feared for their
safety and saw few places of refuge.  In Boyle Heights, gang violence
is a serious problem.  Providers told us that the approximately 30
gangs in the area had a membership of about 15,000.  In 1993, the
police reported 763 gang-related crimes in the Boyle Heights area
alone.  Service providers told us that the teen girls in the area are
at risk of joining gangs--one provider estimated that about 60
percent of the teen girls are already in gang-related activities. 
Although gang-related crimes were not reported to be high in
Washington, D.C., the homicide rate in 1993 for Ward 7 was more than
double that for the whole city.  The girls we spoke with said that
they feared going outside and preferred to stay at home.  One girl
told us that she feels "paranoid .  .  .  wondering which way the
bullet will go."

The physical and economic infrastructure of the neighborhoods we
visited paralleled the social conditions.  The neighborhoods were
characterized by high numbers of public housing units--Washington,
D.C.'s Ward 7 had the highest concentration of public housing units
in the city.  This neighborhood once had a solid middle-class
residential and small business presence.  Today, although the area
continues to be residential with over 70,000 residents, 25.8 percent
of the households were poor in 1990.  In addition, although the area
once had a substantial number of small businesses and stores, it now
has no restaurants, except for fast-food places, and few
opportunities for cultural activities.  Boyle Heights, once an
affluent suburb, is a mixture of aging commercial and industrial
sections and subsidized housing.  West Oakland has no drug stores,
banks, or major grocery stores to serve its more than 15,000
residents. 

   Figure 2:  Neighborhoods GAO
   Visited

   (See figure in printed
   edition.)



   (See figure in printed
   edition.)


      YOUNG GIRLS IN THESE
      NEIGHBORHOODS ARE AT RISK
      FOR MULTIPLE PROBLEMS
---------------------------------------------------------- Letter :3.3

The interplay of family poverty--often with parental substance abuse
and child neglect and abuse--and neighborhoods with few resources
leaves young teen girls at risk for many problems and dangerous
behaviors.  Research studies and reviews have noted the relationship
between adverse living conditions and outcomes that seriously impede
teens' growth to self-sufficiency. 

Family poverty and parental dysfunction are associated with a number
of problems among the children in the household.  First, the
relationship between teen births and poverty is clear.  Nearly half
of the AFDC caseload is made up of women who gave birth during their
teens, and these women are also less likely to have completed their
high school education.  Their children are in poorer overall health
and can, as a result, suffer developmentally--increasing the
likelihood of poor school performance.  Parental drug and alcohol
abuse has been shown to significantly increase the odds that an
adolescent will become a substance abuser.  Likewise, research has
demonstrated a relationship between a woman's being abused as a child
and her becoming a teen mother. 

Neighborhoods with high concentrations of poor families generally
have poor quality schools that, in addition to family economic
stresses, increase the chance that children will fail in school or
drop out.  Children in poor neighborhoods also run a high risk of
becoming both victims and perpetrators of crimes.  Compounding the
problem, because high numbers of youths and adults in these
communities exhibit negative and antisocial behavior, positive
community role models are scarce or absent.  These distressed
communities, with large numbers of children at risk, challenge the
limited number of service providers and the poorly coordinated
overall system of care. 


   COMPLEX NEEDS RARELY REFLECTED
   IN SERVICES FOR YOUNG TEEN
   GIRLS
------------------------------------------------------------ Letter :4

Communities with high numbers of young at-risk teen girls have had
limited success in designing services and approaches that would help
the most vulnerable of these young teens.  The few services for these
girls and their families are typically offered only when problems
reach the crisis state.  Neighborhood residents see providers and
services open and close as funding appears and disappears.  Providers
believed that the services available generally ignore the positive
role a parent can play in a child's development, as well as the
negative impact of a dysfunctional family.  Services designed to help
dysfunctional families, such as mental health and substance abuse
treatment, are either in short supply or far from the neighborhoods. 
Many experts agree that young at-risk teen girls could be better
served if traditional approaches were modified to include early
identification and treatment, long-term program commitment, and
greater community involvement. 


      NEIGHBORHOOD SERVICES NOT
      DESIGNED TO MEET MULTIPLE
      PROBLEMS OF AT-RISK TEENS
---------------------------------------------------------- Letter :4.1

Many of the providers in the neighborhoods we visited said that
supportive services were often provided too late and lacked
continuity.  Most of the human services available to at-risk teens
were crisis-oriented--provided only after a problem had occurred. 
For example, the schools in all communities we visited had
specialized programs for teens who were either pregnant or already
parents of very young children.  Oakland's school-based Adolescent
Family Life Program provided health and supportive services, parent
education, job training, and counseling to teen girls under 17 years. 
However, to be eligible, a girl must be either pregnant or a parent. 
Providers saw the need for a more continuous approach to avoid early
parenthood, such as offering early instruction and counseling or
beginning career orientation programs in primary school.  Early
instruction and counseling is needed, they believed, because of the
shortage of positive adult role models and the fact that these girls
live in neighborhoods that often condone dependency and
submissiveness.  In West Oakland, a middle school counselor told us
that any positive effects on young girls that a program supplying
mental health workers to an elementary school had were eroded when
the program was not continued in high school. 

In addition, service providers cited a number of critical services
needed by young teen girls that were either scarce or nonexistent. 
These include preventive services, such as strategies to avoid early
sexual activity and pregnancy, resist drug use, and avoid gang
membership; after-school recreational activities in a safe
environment; and ways to identify early signs of school failure.  A
counselor at the Boyle Heights Boys and Girls Club saw young girls as
the "forgotten majority." As their performance in school falters or
they leave school because they are pregnant, they are barely missed
by the community institutions, unlike the highly visible and
sometimes violent young boy.  Through our visits to neighborhoods and
local inventories of existing services in those neighborhoods, we
found few service providers who offered preventive care to young teen
girls.  For example, in the Boyle Heights neighborhood, we found only
one prevention program targeting young girls--Education Now and
Babies Later.  Safe and secure locations where young girls could find
recreational activities before and after school and on weekends were
very rare in these communities.  Violent gang activity, especially in
the Boyle Heights neighborhood, where there are reportedly 30
separate gangs, creates an environment of fear.  Several of the young
teens we interviewed said that they felt unsafe walking in their own
neighborhood and often were afraid to come out of their home. 


      FEW SERVICES OFFERED TO
      DYSFUNCTIONAL FAMILIES
---------------------------------------------------------- Letter :4.2

In the neighborhoods we visited, the number and scope of mental
health services, including substance abuse treatment, supportive
services designed to identify potentially abusive parents, and
efforts to prevent abuse from occurring, fell far short of addressing
the communities' problems.  According to providers, community-based
treatment and prevention programs geared to dysfunctional families,
especially those emphasizing mental health and substance abuse
issues, were either not available, in short supply, or located far
from the neighborhoods. 

Community service providers believe that family dysfunction adversely
affects the growth and development of young teen girls and can lead
to long-term dependency on public assistance.  While providers
reported the need for and lack of mental health services for the
young girls in their communities, they also said that the parents
are, at best, not prepared for their role as a parent and, at worst,
need clinical treatment themselves. 

Even when the programs exist, providers said that difficulty in
getting parents involved in their children's activities is a
significant barrier to serving at-risk teen girls.  According to
providers, parents are often unaware of their children's activities;
may condone early sexual activity and childbearing; and give little
attention and support to their children.  Providers told us that
often these characteristics are a function of long-standing and
established patterns of parenting in the neighborhood and a general
sense of hopelessness in the community.  For example, counselors from
a West Oakland middle school estimated that "75 percent of the
mothers are not there for their children." In this school, children
were reluctant to have a day to honor their mothers, and preferred to
have their teachers attend.  In about half the cases, according to a
middle school principal, by the time a young girl reaches middle
school, her household has dissolved and she is living with a
grandparent.\15


--------------------
\15 In 1993, 5 percent of all children were living in a household
with grandparents present (3.7 percent of white children, 12.1
percent of black children, and 5.9 percent of Hispanic children).  Of
the households, 30 percent have only grandparents present--24.9
percent of white households, 38.7 percent of black households, and
22.8 percent of Hispanic households..  See Marital Status and Living
Arrangements. 


      ADOLESCENT SERVICES CAN
      IMPROVE WITH CHANGES IN
      APPROACH AND SCOPE
---------------------------------------------------------- Letter :4.3

Research on the problems of adolescents and their service needs has
reached a number of conclusions about the best approaches to meeting
this population's multiple needs.  For example, OTA's study on
adolescent health--a comprehensive synthesis of the research
findings--notes growing consensus on key components to successful
preventive services for teens.\16 Recognizing along with other
researchers that many adolescents' needs for health and related
services are not being met with mainstream primary care, OTA
concluded that school or community-based centers can offer
comprehensive and accessible services.  Others have joined in
reexamining both programmatic and larger system strategies for
addressing the problems of at-risk teens generally and teen pregnancy
prevention specifically.  They concluded that certain programmatic
changes, moving toward a more comprehensive approach to care, can
lead to greater success.\17 For example, the Urban Institute's review
of program practices designed for at-risk adolescents cited the
following components for a successful program: 

  early identification and intervention;

  long-term and consistent intervention;

  individualized attention, instruction, and counseling;

  emphasis on skills enhancement, life options, and vocational
     orientation;

  development of multiple channels of influence, including parents,
     churches, and community organizations; and

  service delivery in a safe physical environment.\18

Techniques suggested by experts to better integrate community
services include collocating multiple service providers, joint
planning among providers, and new local-level funding strategies.\19

"System" changes involve trying new service delivery approaches and
attempting to reduce conflicts among programs by removing
inconsistencies in program rules and requirements.  In our previous
work, we found that to accomplish these changes, public and private
service agencies need to reorganize administrative structures around
common populations or problems, use more flexible funding approaches,
and create coordinated service planning at different levels of
government.\20


--------------------
\16 Adolescent Health, Vols.  I, II, III, OTA (Washington, D.C.: 
GPO, 1990). 

\17 Risking the Future:  Adolescent Sexuality, Pregnancy, and
Childbearing, Volume I, National Academy of Sciences, National
Research Council Commission on Behavioral and Social Sciences and
Education, Committee on Child Development Research and Public Policy,
Panel on Adolescent Pregnancy and Childbearing, ed.  C.D.  Hayes
(Washington, D.C.:  National Academy Press, 1987); and J.  Dryfoos,
Adolescents At Risk:  Prevalence and Prevention (New York:  Oxford
University Press, 1990). 

\18 Martha R.  Burt and Gary Resnick, Youth At Risk:  Evaluation
Issues (Washington, D.C.:  Urban Institute, 1992). 

\19 Sharon L.  Kagan and Peter R.  Neville, Integrating Human
Services:  Understanding the Past to Shape the Future (New Haven and
London:  Yale University Press, 1993). 

\20 See Integrating Human Services:  Linking At-Risk Families With
Services More Successful Than System Reform Efforts (GAO/HRD-92-108,
Sept.  24, 1992). 


   NEW SERVICE APPROACHES DEPEND
   ON INCREASED COMMUNITY
   LEADERSHIP AND INVOLVEMENT
------------------------------------------------------------ Letter :5

A community's ability to address the problems of at-risk teen girls
depends on more than a collection of programs and service providers. 
Residents and providers in the neighborhoods we visited are becoming
increasingly aware that a coordinated, integrated, and comprehensive
network of services is needed to address the problems of teen girls. 
To do this, neighborhoods may have to overcome deficiencies in their
own leadership and organization. 

Community service providers in the neighborhoods we visited viewed
the emergence of local leadership as an important ingredient in the
development of new service strategies.  They told us that identifying
local leaders to initiate community action, sustain community
support, and help residents gain control over their problems is key
to the organization of better services for young teen girls as well
as adolescents in general.  In Ward 7, West Oakland, and Detroit, for
example, coalitions and networks of local service providers are being
developed to improve the capacity to address community needs and
problems.  Neighborhood coalitions can take various forms.  The
neighborhoods we visited showed that these service coalitions can be
informal--a network consisting of frequent working relationships
among various providers; or they can be a formal, comprehensive
planning and implementation effort that incorporates residents,
merchants, service providers, and the area's public agencies. 
Throughout these cooperative efforts, similar themes shape their
goals and objectives.  Providers believed they have to work
collaboratively with local residents and businesses to deal with the
needs and problems of not only teen girls but also the families and
the communities as a whole.  Most importantly, these communities
realized that the strategies and solutions to their problems must
come from within. 

Local providers also found that they have to coordinate community
activities with one another as well as with other entities in the
community.  For example, providers in Detroit's North High School
neighborhood saw that they needed to link various activities in order
to address the needs and problems facing adolescents, their families,
and the surrounding neighborhood.  Through a major private
philanthropic organization in Michigan, the Kellogg Foundation, a
comprehensive 20-year planning and coordination effort was developed
jointly by the foundation and local providers and residents.  Other
efforts are more informal.  For example, the Teen Life Choices
program in Washington, D.C., established monthly lunch meetings that
included many of the youth service providers in the community.\21
These meetings served as a way to get neighborhood providers to
better understand each other's services, activities, and program
procedures. 

Local providers are also leading efforts to build coalitions with
area schools as a strategy to deliver coordinated programs to the
right age groups.  In all the neighborhoods we visited, junior high
or middle schools have emerged as major "catchments" for programs
serving at-risk teen girls.  For example, West Oakland's Lowell
Middle School and Washington, D.C.'s Evans Junior High School are
working with nonprofit agencies to deliver case management-style
programs in the schools to serve their teen populations.  Oakland's
Lowell Middle School provided on-site case management and support
services for students and their families.  These services included
individual and family counseling, home visits, crisis intervention,
and community service referrals.  Also, a West Oakland middle school
principal is planning a program to include students, parents, and the
community at large.  The program would operate between 4:00 p.m.  and
10:00 p.m.  and would provide a fitness lab, computer/job skills
training, medical information, mental health services, and parenting
courses.  Evans Junior High School's Turning Points program provided
individual counseling and group activities to students as well as
attempted to include parents by developing adult activities and
hiring parents as Turning Points staff.  \22

The collaborative school-based efforts we observed in Detroit and
West Oakland were achieving positive outcomes.  A preliminary
evaluation by the University of California of school-based projects
in West Oakland identified successes in the start-up of the
school-based programs.  These programs were seeing positive responses
from teachers and school officials as well as increased involvement
from teens and their families.  West Oakland found that these efforts
reduced the number of discipline hearing procedures and the number of
suspensions for students in schools receiving the services, when
these students were compared with students in schools not receiving
the services.  In Detroit, the community, along with the Kellogg
Foundation and Henry Ford Hospital, created a teen health clinic
within Hutchins Middle School.  The project reported a reduction in
teen pregnancies from 14 in 1991 to 1 in 1993, immunization for all
children in the school, and improved standardized achievement test
scores over 2 years in both reading and math. 

Both the literature and neighborhood providers told us that key to
the development of any school-based program is the acceptance and
approval of the school's principal.\23

Principals hold significant leverage over school curriculum and
physical space.  In addition, school principals are well informed
about what is going on in school neighborhoods because they
participate in various neighborhood activities and coordinating
councils.  Neighborhood providers and school officials we interviewed
agreed that a program's success depends on the principal's acceptance
of it.  In some cases, programs have to overcome the reluctance of
principals and teachers, who may try to "wait out" new initiatives. 
Providers told us that principals and school staff view new programs
as politically motivated, claiming overly optimistic results, or
requiring school time and physical space that could crowd out other
programs and curricula. 


--------------------
\21 Teen Life Choices ceased operation on Octorber 1, 1994, as a
result of city budget cuts. 

\22 In February 1995, the Turning Points Program at Evans Junior High
School and 14 other middle and elementary schools in Washington,
D.C., was eliminated as a result of the city's budget cuts. 

\23 School-Linked Human Services:  A Comprehensive Strategy for
Aiding Students at Risk of School Failure (GAO/HRD-94-21, Dec.  30,
1993); and The Future of Children:  School-Linked Services, Volume 2,
No.  1 (Los Altos, CA:  The Center for the Future of Children, David
and Lucille Packard Foundation, 1992). 


   CONCLUSIONS
------------------------------------------------------------ Letter :6

The conditions that surround many young at-risk teen girls, which
have replaced the traditional supports provided by functioning
families and safe neighborhoods, have created a group of children
with few options for future success.  These children are among the
most vulnerable and least visible residents of our urban areas, and
are extremely difficult to serve.  Often last in line for services
delivered from a taxed and fragmented delivery system, at-risk teen
girls--if left unserved--will continue to use scarce public resources
and remain waiting to join the rolls of long-term welfare recipients. 
Individual programs alone, while well-intended and innovative in
their approaches, have had little effect on the overwhelming, complex
problems of this population.  Community-designed and -directed
initiatives that coordinate human service programs have shown promise
in some urban neighborhoods in attacking the broader influences that
place the well-being of these children and their families at risk. 
These initiatives need to facilitate collaborative planning,
problem-solving, and program development at the neighborhood level. 
The challenge for both policymakers and program officials is to
develop and implement national strategies that will support local
leadership and at the same time foster cooperative ventures among
local service providers. 


---------------------------------------------------------- Letter :6.1

Because this report focuses on local responses to at-risk teens and
their families, we did not obtain agency comments.  We did discuss,
as a part of our field work, our observations with local providers
and program officials. 

We are sending copies of this report to relevant congressional
committees and other interested parties.  Copies will also be made
available to others upon request. 

This work was done under the direction of David D.  Bellis.  If you
or your staff have any questions concerning this report, please call
him on (202) 512-7278 or me on (202) 512-7215.  Other major
contributors are listed in appendix III. 

Sincerely yours,

Jane L.  Ross
Director, Income Security Issues


SCOPE AND METHODOLOGY
=========================================================== Appendix I

To develop the information for this report, we collected and reviewed
the literature on adolescent health and service approaches to at-risk
teens.  In addition, we reviewed studies on teen pregnancy and
prevention and analyzed data collected by the Bureau of the Census. 
We also contacted program officials from federal agencies and
representatives from organizations who were familiar with this
population and its service needs. 

We visited three urban neighborhoods for close review--Ward 7 in
Washington, D.C.; Boyle Heights in Los Angeles, California; and West
Oakland in Oakland, California--to document the availability of human
services for at-risk teen girls; the barriers to serving this
population; and how communities are responding to this population's
service needs.  We selected these neighborhoods because they had (1)
high numbers of at-risk teens who had characteristics such as high
rates of poverty, teen births, and crime; and had (2) some services
for young adolescents.  In addition, we visited a community
development program in Detroit, Michigan, that was supported by a
private foundation.  We interviewed local officials, service
providers, and young teen girls served by service providers to
identify the programs and problems in these neighborhoods.  We did
our work between September 1993 and December 1994 in accordance with
generally accepted government auditing standards. 


PROFILES OF THE THREE
NEIGHBORHOODS REVIEWED
========================================================== Appendix II


   BOYLE HEIGHTS, LOS ANGELES,
   CALIFORNIA
-------------------------------------------------------- Appendix II:1

Boyle Heights, located east of downtown Los Angeles, is one of the
oldest communities in the city.  Since the 1940s, Boyle Heights has
been populated by first-, second-, and third-generation families of
predominantly Mexican heritage.  The community has become an
important point of entry for thousands of new immigrants since the
1970s.  Boyle Heights has a population of over 94,000, and 94 percent
are of Hispanic origin. 

The majority of the area's housing was built in the 1920s.  Single
family houses compose 43 percent of the residential area.  Six of the
21 public housing projects in Los Angeles are located in Boyle
Heights, which include 2,166 units for about 8,300 residents. 
Commercial and industrial corridors in the area were developed in the
1920s and 1930s and currently include clothing and fabricated metal
production.  The predominant retail trade businesses are restaurants,
groceries, and clothing stores. 

Almost 70 percent of the households are low income, and the area has
a poverty rate of about 30 percent, compared with a citywide rate of
19 percent.  In 1990, the unemployment rate was almost 14 percent, 8
percent citywide.  Approximately 3,000 of the area's 14,500
school-age children are in AFDC households, and the area has the 11th
highest number of children receiving free and reduced-price meals in
Los Angeles County. 

The crime rate in Boyle Heights is higher than in the city as a
whole, with homicide at almost twice that of all of Los Angeles;
1991-93 averages were 13 homicides per 10,000 versus 7 per 10,000 for
the whole city.  Gang violence is a serious problem.  Local providers
estimate that about 30 gangs operate in the Boyle Heights
neighborhood.  According to Los Angeles Police Department data, 763
gang-related crimes were committed in the district covering Boyle
Heights in 1993. 

   Figure II.1:  Boyle Heights,
   Los Angeles, California

   (See figure in printed
   edition.)


      CONTACTS MADE IN BOYLE
      HEIGHTS NEIGHBORHOOD
------------------------------------------------------ Appendix II:1.1

Aliso Pico Multipurpose Center
Barrio Action Group
Booth Memorial Center (residential care for pregnant teens)
Boyle Heights Continuation High School
Catholic Charities Brown House
City of Los Angeles, Department of City Planning
City of Los Angeles, Housing Authority
County of Los Angeles, Adolescent Family Life Program
County of Los Angeles, Department of Children's Services
County of Los Angeles, Department of Health Services
County of Los Angeles, Division of Alternative Education
Eastside Revitalization, Community Redevelopment Agency
El Centro (mental health services)
Hollenbeck Junior High School
Hollenbeck Youth Center
Latino Family Preservation Project
Los Angeles Department of Public Social Service, GAIN Division
Los Angeles Police Department
Los Angeles Unified School District
Ramona Gardens Community Service Center
Ramona Junior High School
Ramona High School
Roosevelt High School
Salesian Boys and Girls Club
St.  Anne's Maternity Home
United Way
Variety Boys and Girls Club


   WEST OAKLAND, OAKLAND,
   CALIFORNIA
-------------------------------------------------------- Appendix II:2

Over the past 40 years, West Oakland has declined from a vibrant
working-class community to a decaying neighborhood.  Neighborhood
conditions began to deteriorate after World War II, when houses built
for wartime workers were torn down as defense-related jobs dwindled. 
Also, large public construction projects, such as the Cypress
Freeway, a Bay Area Rapid Transit station, and a main postal
facility, displaced families, destroyed homes, and separated
commercial activity from the neighborhood.  Since the 1970s, the
neighborhood has been unable to regain the local businesses it once
had--the neighborhood has no drug stores, banks, or major grocery
stores. 

West Oakland has 12 public housing projects and one of the city's
highest concentrations of Section 8 housing assistance recipients. 
In addition, 39 percent of all housing units in West Oakland are
assisted housing, in contrast to 10 percent for the entire city of
Oakland. 

West Oakland has poverty and unemployment rates that far exceed those
of Oakland as a whole.  About 34 percent of West Oakland residents
live in poverty, almost double the city average of 19 percent. 
Moreover, more than half (55 percent) of the youths living in West
Oakland are poor, compared with 30 percent citywide. 

West Oakland is a dangerous neighborhood.  West Oakland's crime rates
exceed those in the rest of the city, with a homicide rate that is
more than double the citywide average, and rape and burglary rates
that are almost 150 percent higher. 

   Figure II.2:  West Oakland,
   Oakland, California

   (See figure in printed
   edition.)


      CONTACTS MADE IN WEST
      OAKLAND NEIGHBORHOOD
------------------------------------------------------ Appendix II:2.1

Adolescent Family Life Program
Alameda County Housing Authority
Alameda County Welfare Department
Bananas (teen parent services)
Big Brothers and Big Sisters
Carter Middle School
Catholic Charities
Child Health and Disability Prevention
Child Protective Services (foster care)
Children's Hospital
Comprehensive Teenage Pregnancy and Parenting Program
Court Appointed Special Advocate
Dream West (education program)
East Bay Omega Club
East Bay Perinatal Council, Adolescent Family Life Program
Education Now, Babies Later
Emergency Services Network
Florence Crittenton Services
George Schnotlan Youth and Family Center
Girls Incorporated (community organization/center)
Gladman Memorial Hospital
Hillcare Health Services
Imani House (community organization/center)
Lowell Middle School
Marcus A.  Foster Educational Institute
McClymonds High School
Mental Health Services for Children and Youth
National Runaway Switchboard
Pregnancy Crisis Center
Oakland Birth to Schools
Oakland Housing Authority
Oakland Office of Health and Human Services
Oakland Parent Child Center
Oakland Parks and Recreation
Oakland Unified School District (Comprehensive Health and Safety
 Program)
Teen Counseling Helpline
Thurgood Marshall Family Resource Center
United Way
Urban Strategies Council (community organization/center)
We Speak
West Oakland Health Center (teen clinic)
West Oakland Mental Health Center
Youth Crisis Runaway Hotline


   WARD 7, WASHINGTON, D.C. 
-------------------------------------------------------- Appendix II:3

Ward 7 is the easternmost ward in Washington, D.C., and it is
physically separated from the central and western sections of the
city by the Anacostia River.  Although it was never among the
wealthiest of the District's communities, Ward 7 once had a solid
base of middle-class families, as well as a substantial number of
small businesses and retail establishments.  However, the
out-migration of many middle-income families and businesses, which
began in the 1970s, has helped to destabilize the ward. 

Ward 7 has the highest concentration of public housing stock in the
city, one-third of the city's total stock--or about 2,880 units.  In
1990, Ward 7 had a population of about 73,000, as compared with over
86,000 in 1980.  The neighborhood in Ward 7 we visited had about
43,000 residents.  Over 25 percent of the Ward's residents live in
poverty.  In contrast, about 17 percent of the total Washington,
D.C., population lives in poverty.  Forty-six percent of the
neighborhood's 32,473 adult residents (16 and older) were either not
in the labor force or not employed. 

Nearly 5,300 families, or 67 percent of the Ward's families with
children, were headed by a single parent.  Further, 26 percent of its
population was under 18 years of age in 1990.  About 20 percent of
all births in the neighborhood were to females under age 20. 

In 1993, the Ward 7 neighborhood accounted for 64, or about 14
percent, of the city's 453 homicides and 11 percent of the reported
rapes that occurred in the city. 

   Figure II.3:  Ward 7,
   Washington, D.C.

   (See figure in printed
   edition.)


      CONTACTS MADE IN WARD 7
------------------------------------------------------ Appendix II:3.1

African Heritage Dancers and Drummers
Ballou High School (Project We Care)
Best Friends (mentoring program)
Center for Law and Social Policy
Center for Substance Abuse Prevention
Center for Youth Services
Children's Trust Neighborhood Initiative (case management and social
 support)
Columbia Hospital Teen Center
Community Health Care, Inc.
D.C.  Bureau of Training and Employment, JOBS Program
D.C.  Department of Child Protective Services
D.C.  Department of Recreation
D.C.  Department of Human Services, Office of Maternal and Child
Health
D.C.  Healthy Start
D.C.  Mayor's Youth Initiative
East Capitol Dwellings
East of the River Health Clinic
Edward Mazique Parent/Child Center
Greater Washington Boys and Girls Club--Jelleff House (residential
 program)
Greater Washington Urban League
James Bell and Associates
Kenilworth-Parkside Recreation Center
Marshall Heights Community Development Organization
Metropolitan Police Boys and Girls Clubs
People's House (hotline and referral service)
Planned Parenthood of the Metropolitan Washington Area
Richardson Elementary School
Roving Leaders Program (counseling and referral service)
Sasha Bruce Youthwork
SYNERGY (adolescent health community coalition)
Teen Life Choices
Turning Points Program at Evans Junior High School
United Black Fund
U.S.  Department of Justice, Office of Juvenile Justice Programs


GAO CONTACT AND STAFF
ACKNOWLEDGMENTS
========================================================= Appendix III

GAO CONTACT

David Bellis, Project Manager, (202) 512-7278

ACKNOWLEDGMENTS

The following individuals also made important contributions to this
report:  Valerie Rogers, Evaluator; John Vocino, Senior Evaluator;
Lisa Shibata, Evaluator; Pamela Brown, Evaluator; and Margie Shields,
Senior Evaluator. 





RELATED GAO PRODUCTS
============================================================ Chapter 0

Community Development:  Comprehensive Approaches Address Multiple
Needs but Are Challenging to Implement (GAO/RCED/HEHS-95-69, Feb.  8,
1995). 

Families on Welfare:  Teenage Mothers Least Likely to Become
Self-Sufficient (GAO/HEHS-94-115, May 31, 1994). 

Families on Welfare:  Focus on Teenage Mothers Could Enhance Welfare
Reform Efforts (GAO/HEHS-94-112, May 31, 1994). 

Foster Care:  Parental Drug Abuse Has Alarming Impact on Young
Children (GAO/HEHS-94-89, Apr.  4, 1994). 

Residential Care:  Some High-Risk Youth Benefit, But More Study
Needed (GAO/HEHS-94-56, Jan.  28, 1994). 

School-Linked Human Services:  A Comprehensive Strategy for Aiding
Students at Risk of School Failure (GAO/HRD-94-21, Dec.  30, 1993). 

Integrating Human Services:  Linking At-Risk Families With Services
More Successful Than System Reform Efforts (GAO/HRD-92-108, Sept. 
24, 1992). 

Child Abuse:  Prevention Programs Need Greater Emphasis
(GAO/HRD-92-99, Aug.  3, 1992). 

Public And Assisted Housing:  Linking Housing and Supportive Services
to Promote Self-Sufficiency (GAO/RCED-92-142BR, Apr.  1, 1992).